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Why This Topic Is Important
Sexual health is a critical component of overall teen health and is influenced by complex factors including biology, socioeconomics, community environments, relationships with family and peers, and access to health care and education (1). While sexuality is a normal part of adolescent development, sexual activity can have serious consequences, including sexually transmitted infections (STIs) and unintended pregnancy. It is estimated that although young people ages 15-24 represent about 25% of the sexually active population in the U.S., they account for 50% of the nearly 20 million new STI cases each year (2). Estimates also indicate that one in four sexually active adolescent females has an STI (3).

Among infectious diseases that must be reported to the U.S. government, chlamydia and gonorrhea are the most common, with young people (ages 15-24) having the highest rates of infection when compared with other age groups (3). Nationwide, African American/black youth experience especially high rates of chlamydia and gonorrhea; in 2017, black youth ages 15-19 were diagnosed with chlamydia at more than five times the rate for white youth of the same age, and with gonorrhea at more than 11 times the rate of their white peers (3).

Chlamydia and gonorrhea infections are often asymptomatic, particularly in women, so regular screenings are critical in order to provide timely treatment and to reduce disease transmission (2, 3). If untreated, chlamydia and gonorrhea can lead to chronic pain, pelvic inflammatory disease, infertility, and adverse reproductive outcomes (2, 3).

STIs also have serious economic consequences. In 2013, the CDC estimated that, overall, STIs cost the U.S. health care system about $16 billion annually (2).
For more information on teen sexual health, see kidsdata.org’s Research & Links section. Also see Teen Births on kidsdata.org.

Sources for this narrative:

1.  Plourde, K. F., et al. (2016). Improving the paradigm of approaches to adolescent sexual and reproductive health. Reproductive Health, 13, 72. Retrieved from: https://reproductive-health-journal.biomedcentral.com/articles/10.1186/s12978-016-0191-3

2.  Centers for Disease Control and Prevention. (2013). Incidence, prevalence, and cost of sexually transmitted infections in the United States. Retrieved from: https://npin.cdc.gov/publication/incidence-prevalence-and-cost-sexually-transmitted-infections-united-states

3.  Centers for Disease Control and Prevention. (2018). Sexually transmitted disease surveillance 2017. Retrieved from: https://www.cdc.gov/std/stats17/toc.htm
Policy Implications
Young people need accurate, appropriate, and comprehensive sexual health information, access to quality health care, and supportive families, peers, and communities in order to make safe, informed choices about sexual activity (1, 2). California law requires integrated, comprehensive sexual health and HIV prevention education in middle school and high school, and mandates that instruction and materials be appropriate for students of all ages, genders, racial/ethnic and cultural backgrounds, sexual orientations, and those with disabilities (3). In addition to providing tailored education and health services for adolescents, efforts to improve teen sexual health should focus on promoting protective factors associated with reduced sexual risk-taking (e.g., strong family and peer relationships) and addressing underlying social conditions and systemic barriers (e.g., racial and income disparities in access to quality health care) that influence health behaviors and outcomes (2, 4). Although California has a strong track record of promoting adolescent health, state data show persistent disparities in teen sexual and reproductive health by race/ethnicity and geography (2).

California youth have the right to confidential sexual health services—related to sexually transmitted diseases (for ages 12 and older), contraception, pregnancy, and abortion—but some teens, doctors, and parents/guardians may not fully understand those rights (5). Insurance coding and reimbursement can be a challenge to confidentiality as it can reveal the nature of the doctor visit to parents/guardians, though California law now allows patients to request that sensitive information be kept from primary policyholders (6).

Policy and program options to improve teen sexual health include:
  • Promoting routine sexuality education by pediatricians, which can be a useful supplement to information provided at school or home, and exploring ways to remove barriers to such education (e.g., time, training, reimbursement issues, etc.), as many pediatricians do not provide it (7)
  • Continuing to ensure that public health and reimbursement policies support broad, routine screening of youth for chlamydia and other sexually transmitted diseases, and that health care services are accessible, culturally-appropriate, and sensitive to teen needs, e.g., providing care at school- or community-based locations and offering extended hours (4, 8)
  • Ensuring that the California Healthy Youth Act, which expanded sexual education requirements for schools, is implemented effectively across the state (3, 9)
  • Encouraging policies and programs that strengthen family relationships (including parent-child communication about sexual health), help youth develop positive, meaningful connections to peers and other adults, and provide safe, supportive community and school environments (1)
  • Promoting cross-sector efforts that go beyond individual factors to address larger societal and system forces affecting teen sexual health, such as media influences, economic opportunities, and access to quality health care, particularly for youth of color and those in low-income or rural areas (1, 2, 10)
  • Supporting efforts to study and identify effective methods to use digital and social media as positive tools to promote healthy sexual development; this may involve identifying ways to help parents and youth manage negative media influences (10)
For more policy ideas and research on this topic, see kidsdata.org’s Research & Links section, or visit Essential Access Health or the Guttmacher Institute. Also see Policy Implications on kidsdata.org under Teen Births and Health Care.

Sources for this narrative:

1.  Plourde, K. F., et al. (2016). Improving the paradigm of approaches to adolescent sexual and reproductive health. Reproductive Health, 13, 72. Retrieved from: https://reproductive-health-journal.biomedcentral.com/articles/10.1186/s12978-016-0191-3

2.  California Department of Public Health, Maternal, Child and Adolescent Health Program. (2016). California Adolescent Sexual Health Needs Index, 2014. Retrieved from: https://www.cdph.ca.gov/Programs/CFH/DMCAH/CDPH%20Document%20Library/Data/Adolescent/CA-Adolescent-Sexual-Health-Needs-Index-2014.pdf

3.  California Sexual Health Education Roundtable. (n.d.). California Healthy Youth Act frequently asked questions. Retrieved from: https://www.aclunc.org/docs/frequently_asked_questions-california_healthy_youth_act-ca_sexual_health_education_roundtable.pdf

4.  Centers for Disease Control and Prevention. (2018). Sexually transmitted disease surveillance 2017. Retrieved from: https://www.cdc.gov/std/stats17/toc.htm

5.  National Center for Youth Law. (2018). California minor consent and confidentiality laws. Retrieved from: http://teenhealthlaw.org/wp-content/uploads/2018/11/CaMinorConsentConfChartFull11-20-18.pdf

6.  American Civil Liberties Union of California, et al. (2016). Confidential Health Information Act: New insurance confidentiality protections for Californians. Retrieved from: http://www.essentialaccess.org/sites/default/files/SB138_Confidential_Health_Information_Act%20_Fact_Sheet.pdf

7.  Breuner, C. C., et al. (2016). Sexuality education for children and adolescents. Pediatrics, 138(2), e20161348. Retrieved from: http://pediatrics.aappublications.org/content/138/2/e20161348

8.  American Academy of Pediatrics Committee on Adolescence, & Society for Adolescent Health and Medicine. (2014). Screening for nonviral sexually transmitted infections in adolescents and young adults. Pediatrics, 134(1), e302-e311. Retrieved from: http://pediatrics.aappublications.org/content/134/1/e302

9.  Adolescent Sexual Health Work Group. (2017). Current and relevant resources to support local implementation of comprehensive sexual health education in California schools. Retrieved from: http://ashwg.org/wp-content/uploads/2017/09/ASHWGResourceList-9.22.17.pdf

10.  Collins, R. L., et al. (2017). Sexual media and childhood well-being and health. Pediatrics, 140(Suppl. 2), S162-S166. Retrieved from: https://pediatrics.aappublications.org/content/140/Supplement_2/S162
How Children Are Faring
According to 2015-16 estimates, 81% of California teens ages 14-17 had never had sex. Young people who engage in sexual activity may be at risk for sexually transmitted infections such as chlamydia and gonorrhea; in 2017, 48,472 cases of chlamydia and gonorrhea were reported among California youth ages 10-19. Statewide, youth chlamydia and gonorrhea rates have fluctuated since 2000 but have increased overall, from 635 cases of chlamydia per 100,000 youth ages 10-19 in 2000 to 763 per 100,000 youth in 2017, and from 98 cases of gonorrhea per 100,000 youth in 2000 to 138 per 100,000 in 2017. In California and across most counties, data from 2017 and previous years show that female youth are diagnosed with chlamydia and gonorrhea at higher rates than their male counterparts. Although teens ages 15-19 account for the vast majority of chlamydia and gonorrhea cases among youth in California, there also were 850 cases involving children ages 10-14 in 2017.